Brazil Challenges

July 12, 2015

Juliana Barbassa is a person I've known through the grapevine for years since she arrived in Rio as the Associated Press correspondent. I didn't meet her in person until two years ago, when I was in Rio at the tail end of the massive street protests. I was fascinated by her trajectory and her unique eye for reporting in Brazil.

Barbassa was born in Brazil, but grew up all over the world because of her dad's oil company job, living not only in Rio but also in Iraq, Malta, Libya, Spain, France, and the United States. She went to UT Austin for undergrad and to UC Berkeley for graduate school. She joined the AP in 2003, and became the AP Rio correspondent in 2010.

Back in 2013, Barbassa was kind enough to invite me over to her beautiful home in Flamengo, where I also met her dad and now-husband Christopher Gaffney, every Rio journalist's favorite curmudgeon and one of the top experts on global mega-events. We talked about the protests and the World Cup and Barbassa's career and what it was like to go from writing for a wire service to writing her first book. We also talked about her experience going to grad school for journalism, which in retrospect I credit her for inspiring me to do.

That meeting confirmed what I suspected: that Barbassa is someone special when it comes to understanding Brazil and being able to translate its cultural idiosyncrasies. She's able to capture the nuances of a native while also providing the perspective of an outsider.

And now, finally, you can see the result of Barbassa's hard work with her new book, coming out July 28. (Pre-order your copy of the book here.) Below, see my impressions of the book, my Q&A with the author, and when you can meet Barbassa during her book tour.

My Thoughts on the Book

Called Dancing with the Devil in the City of God: Rio de Janeiro on the Brink, the book explores what's been happening in Rio over the last few years in a way that I really think has never been captured as well as she does. The reporting is incredibly deep and thorough, from poring through documents to an exhausting number of hours spent in the field.

Overall, the book is exquisitely written, a blend of a memoir and some of the best reporting you will find on Rio de Janeiro. Some parts are heart-wrenching (see the chapter on the mudslides), and some parts are laugh-out-loud funny (don't miss the anecdote about the Mexican entrepreneur and how he got his Brazilian visa.)

Not only does she get into the nitty gritty of security, gentrification, evictions, environmental degradation, and mega-event preparation, but she digs deep into the history of Rio's ongoing conflict. She revealed things that were new even to me, including a Rio policy that helped drive killings by police.This book should be required reading for any journalist who plans on covering the 2016 Olympics.

And instead of devoting a whole chapter to 500 years of Brazilian history, as is common in English-language non-fiction books about Brazil, she elegantly weaves historical facts into the narrative about what's happening now. And when she explores historical sites few people even know about it, you feel like you're there with her.

Barbassa combines the reporting with her own story of living in Brazil and around the world, making it an even more intriguing read. (Warning: if you have ever lived in Brazil, her chapter on trying to find an apartment may give you PTSD flashbacks.)

And even though during her time in Rio she went from being single to getting married, her relationship isn't part of the book. For this I really admire her, since this is usually a big part of female-written memoir-style books. It's clear that her time in Rio was a personal journey about coming to terms with her birthplace.

What was the most surprising thing you learned while researching the book?

I was taken back by the early history of the Comando Vermelho. When I first became aware of the gang in the late 1980s, they were already a powerful, violent entity making headlines with boastful interviews, a cinematic prison escape, or bloody confrontations with police. But they had that motto, Peace, Justice and Liberty. It seemed incongruent.

Reading about the gang’s early days in the Ilha Grande prison from books like “Quatrocentos Contra Um” or Carlos Amorim’s “Comando Vermelho” made me curious about the environment that shaped these men and their aspirations. I sought out those who were there or remember that time, like the Professor, dug for old news clippings, and finally, searched what’s left of the uncategorized prison archives, trying to understand who they were, how they lived, what influenced their thinking.

In particular, I spent hours going through daily prison logs, fascinated by the the minutia of everyday life in this terrible place - who fought with whom, which prisoners were punished for smoking marijuana, gambling, fighting, what there was to eat, what each man brought with him when he came in, who got visits. Much of it was mundane and unvarying, but the accumulation of details made them, their needs, their cells more real.

I enjoyed most the occasional finds that came from from the hands of the prisoners themselves -- a crude playing card made from the page of an encyclopedia, part of a seized deck, that was stuck inside one of the thick log books; the letters from inmates to those on the outside. The best examples of those were in the little museum that now exists on the site of the demolished prison: they have missives written by gang members on the inside asking their ‘brothers’ for some help with the prisoners’ Christmas celebration. These things were reminders of a time when the Comando Vermelho was an entirely different creature.

Was there a part that got cut that you especially liked?

Of course! There were long sections cut out to streamline the story. Within them were characters who deserved whole chapters to themselves -- in another book. One of my favorites was the section about Flávia Froes, an attorney whose list of clients reads like a who’s-who of Rio’s drug traffic dating back to the 1990s. She dredges up references to class warfare to frame the conflict between the state and gang members convicted in horrific murders.

But she’s not a lefty, bleeding heart sort; she’s tough, and she plays her over-the-top Carioca sexy to the hilt. The first time we met she was picking her way around crack users in trash-strewn alleys wearing six-inch stiletto heels, rhinestone studded jeans and a corset, her long blond hair swaying down to the middle of her back. But when we made our way to the heavily-armed dealers standing guard over tables stacked with baggies of crack, they respected her: it was all, “yes, ma’am,” “no, ma’am.” What makes her interesting as a person, and as a character, is that you’re left wondering how far she would be willing to go -- how far she has gone -- for her clients.

During the days of chaos that preceded the take-over of the Complexo do Alemão, when someone was carrying orders from imprisoned gang leaders to their soldiers on the outside, a judge ordered her arrest. Forty officers and a helicopter were sent out, but she got wind of it and went on the lam without a computer or a cell phone, untraceable. Later the charges were dropped for lack of proof, and Flavia was back, jaunty as ever, but there are many who never got over their doubts.

How did the book-writing experience compare to your work with the AP?

Daily news has specific requirements -- you work under deadline, keep your articles short and to the point. That’s the nature of news. It often meant having to do grab-and-run interviews, leaving before the conversation got really interesting; other times it simply meant leaving much of the nuance out of the final article.

My motivations for writing this book were many, but at the core was a desire for more time to report and more space to write. This came, in part, from my relationship to Rio. I wanted to bring the city to readers, but I also wanted to get into it myself, really get into it. Covering the city as a correspondent gave me breadth of experiences; reporting the book allowed me to return to the same person or place and see various layers. It gave me depth.

What do you miss most about living in Rio?

Living with my windows wide open all the time, except when it stormed. But then I miss the spectacle of those extravagant summer downpours. Friends and family, of course, particularly my nieces and nephews. The açaí from Tacacá do Norte in Flamengo. All the fruit. And the fresh fruit juice. The sweet man with the white handlebar mustache who sold vegetables at the farmers’ market in front of my building, and greeted me with a hug and a kiss every week. Running on the sand. The weather. I even miss the heat!

Why should people protest? Are protests valid if demonstrators are largely white and middle class? Were all of today's protestors middle class? Are protests legitimate if their demands are unreasonable? Are protests useful if they lack a coherent, central demand? What constitutes a legal reason for impeachment? What does a civil political debate look like? Is asking for an impeachment process unreasonable? Is it okay to criticize a political party you consider yourself part of? Why are people calling for a return to the dictatorship? Are opposition supporters just being sore losers?

Even the crowd counts showed evidence of conflicting visions of today's events. Crowd estimates varied within cities; São Paulo numbers ranged from 210,000 to 1 million, for example. But overall, it's estimated that hundreds of thousands turned out nationwide. Totals range between 1 and 2 million.

Some protestors spoke out against corruption, and some demanded the president's impeachment. A minority went so far as to ask for military intervention and the dismantling of government institutions. Meanwhile, today marked the 30-year anniversary of the end of Brazil's military dictatorship.

The protests came during an increasingly tense political atmosphere in the wake of one of the country's closest presidential elections last October. But it's also the result of mounting tensions of more than a decade of leadership by the Workers' Party, along with an ever-evolving corruption scandal, a weakened economy and a stagnant quality of life.

The demonstrations were marked by the increasingly bitter and vitriolic political dialogue in the country, with some PT loyalists accusing protestors of being golpistas, in favor of overthrowing the government, and accusations against the PT of communism by some on the right.

There were also signs of cognitive dissonance: those marching in favor of military intervention (who wouldn't have the freedom to protest under authoritarianism), and those using Brazilian Soccer Federation jerseys to protest against corruption.

But all in all, what do the day's events indicate?

First, on the positive side, I think it's a sign that Brazilian democracy is alive and well 30 years in. Demonstrations on this scale are significant in a country like Brazil, which doesn't see huge protests on a regular basis like some of its neighbors. And while it's disturbing and even laughable to see people asking for military intervention, the fact that people can even say things like that publicly stems from their ability to exercise to free speech. The big turnout could also be seen as a response to complaints about "slacktivism" and sticking to social media to express political dissent.

It's also good to see people making demands of their leaders, even if they are vague demands. After the protests, two government ministers went on TV to recognize the day's events and to announce upcoming anti-corruption measures. One would expect people to make demands given the president's approval rating, measured at around 23 percent in February by Datafolha. In other words, the opposition may be shouting loudest, but not many people are happy with the president on either side of the aisle.

On the other hand, political literacy is lacking. It's not clear that all pro-impeachment protestors understand the process involved about who would actually take over in the event of an impeachment. One foreigner reporter found that to be the case:

Only one of the dozen protesters I interviewed understood the legal basis for impeachment. The rest just knew they were fed up with…

On the flip side, those who accuse impeachment supporters of being coup-supporters show a lack of understanding or positioning about the constitutional legality of impeachment. In fact, impeachment has happened before, to President Fernando Collor de Mello in the 1990s.

Debates over today's protests were also indicative of the level of political dialogue that has been going on since last year. People have lost friends and squabbled with family members over politics in these debates, and these demonstrations provided a new forum for political arguments.

The big take-away for me is that some are still unhappy with the status quo, even more so than in 2013. It's not just about being upset about the election, or about the value of the real, or about being sick of the PT. It's about being dissatisfied with the country's direction. And the truth is that the president isn't just facing critics on the right: she's facing them on the left, too.

This, like it or not, is what democracy is all about. There's a lot of debate and disagreements, and sometimes they're really bitter. But it also means you can express your views freely, no matter how logical or unreasonable they may be. The next step is coming up with solutions in addition to complaints.

February 22, 2015

Transparency is part of the lifeblood of a democracy, especially in a crisis, though governments are not always honest. But in the age of social media, it's getting harder for officials to hide information. Such is the case of water rationing in São Paulo during the worst drought there in eight decades.

Urban water use accounts for only 9 percent of all water use in Brazil, while irrigation makes up a whopping 72 percent. Nevertheless, the drought has hit São Paulo residents and farmers alike. Many consumers in São Paulo have been dealing with some form of shortages during the drought, forcing them to be strategic about how they use water. Yet for a long time, local officials denied there was rationing.

In reality, water rationing has taken place across São Paulo for months, first reportedly beginning a year ago. But São Paulo Governor Geraldo Alckmin only publicly admitted rationing for the first time on January 14 and Sabesp, the state water utility company, only began releasing information about rationing schedules on January 27. Also last month, an official from São Paulo’s water utility company made an announcement about a drastic measure: residents of Brazil’s biggest city could potentially face five days of water rationing per week if rainfall doesn’t pick up. While unnerving, it was also honest in the face of denial for so many months.

But rationing is hardly a secret, after being widely reported in the press and on social media. While officials refused to explain what was really happening, São Paulo residents took to Facebook, Instagram, and Twitter to reveal what they saw around them. Last year, there were 6.5 million tweets about the water crisis, and as of early February, there were nearly 900,000 tweets in 2015 alone.

In fact, one of the reasons Sabesp started revealing information about locations and times of rationing stems from a social media campaign. Using the #ToSemAgua hashtag in a campaign organized by the Brazilian Consumer Defense Institution and Minha Sampa, participants asked São Paulo residents to email government and Sabesp officials to make rationing locations and schedules publicly available. They finally succeeded last month.

To complain about shortages and to spread information about rationing, some São Paulo residents are using the hashtag #SPSemAgua, which means “São Paulo without water.” It first started appearing on Twitter in February 2014, when rationing reportedly began, and has since picked up steam as shortages spread. Newspaper O Estado de São Paulo is tracking the hashtag across Twitter, Facebook, and Instagram, allowing readers to submit their shortage experiences. There are other hashtags as well, such as #CadeAguaSP (Where's the water in São Paulo?) There's also a site called Faltou água, which crowdsources reports São Paulo residents to submit their location and how often they’re experiencing water rationing.

Here are a few examples of what social media users have shared about the water crisis:

a joke event called "My Shower, My Life at Governor Alckmin's House" on Facebook, gathering tens of thousands of "participants"

In addition, there's also a Tumblr and Twitter account called Boletim da Falta D'Água (Water Shortage Bulletin), which shares updates on the drought, the latest levels of water reserves and rain forecasts, what leaders are saying, and what's actually happening.

São Paulo has been getting rain recently, but the problem isn't solved yet. The experience provides an important lesson that in the age of social media, it's a really bad idea to try to cover up a crisis.

December 30, 2014

It's been an exciting year to watch Brazil, especially since the world was also watching, given the World Cup and the presidential election. But there's also plenty else going on, from an ever-changing middle class to the country's security challenges. Here are highlights from the blog.

A Brazilian fan watches the 2014 World Cup in Salvador.

The World Cup: Despite ominous predictions, the international mega-event went well, for the most part. Brazil was eliminated from the tournament in a devastating loss, but Brazilians' attitudes on the World Cup overall and their team's defeat showed how the country has changed since it last hosted the games in 1950.

2014 Elections: This year's federal and state votes were like something out of a movie. A presidential candidate died in a plane crash, a former presidential candidate took his place, and the presidential runoff was one of the closest in years. The election caused a huge amount of debate and divisiveness, which will set the stage as the president starts her second term and as Brazil's most conservative Congress since redemocratization takes office next year.

Brazil's New Middle Class: As Brazil's economy has slowed to a crawl, interest in the country's growing "new middle class" has also dimished. But the truth is that this massive group of people continues to be one of the most important ones to watch. From January's youth "rolezinhos" to a series of strikes ahead of the World Cup to local protests against violence, Brazil's new middle class continues to redefine itself.

Security and Pacification: Security remains one of Brazilians' top concerns. Whether it's continued efforts to "pacify" Rio's favelas or vigilantes taking the law into their own hands, the debate remains about how the authorities should best address public security.

Journalism and Social Media: Brazilians are using a variety of online tools, from Facebook to Twitter to Instagram, to debate some of the country's most important issues, ranging from mega-events to security to politics.

December 16, 2014

Over the past few months, I've witnessed thousands of fellow New Yorkers hit the streets to protest in favor of civil rights, and through social media I've seen friends around the country speak out against racial injustice. The cases of Michael Brown, Eric Garner, and Tamir Rice have brought issues to the fore that have galvanized young people all over the United States. These three cases have come to represent the many young black men who die violently each year. In the United States, young black men are 21 times more likely to be shot and killed by police than their white counterparts, and the overall homicide rate for black male teenagers is more than 20 times higher than that of white male teens.

It's a similar story in Brazil, but one that people don't often talk about. In Brazil, 30,000 people ages 15 to 29 are murdered each year, or around 82 young people killed every day. Of those victims, 77 percent are black. On average, police kill more than five people daily. And overall, only 5 to 8 percent of homicides go to trial.

In spite of these overwhelming numbers, Brazil hasn't had a big case to widely stir people to action--yet.

With this in mind, I asked Alexandre Ciconello, a human rights adviser at Amnesty International Brazil, about his organization's mission to raise awareness about this issue and how Brazil's struggle with black deaths parallels the same problem in United States. Ciconello monitors issues of public security, violence, and the judicial system.

Black Youth Alive is an Amnesty International campaign that seeks to put an end to the high number of homicides and of black youth in particular. Through communication, social media, and activism, we hope to put a stop to people's indifference in relation to the high rates of youth homicides, especially black youth in Brazil, so people mobilize and speak out in favor of youth staying alive.

This initiative is relevant given the rise in murders in Brazil. Plus, there's been a trend in recent years in which the number of homicides among the black population has risen, while the murder rate fell among the white population. The main group of victims are black youth, many of them residents of favelas or city outskirts. The majority of victims' profiles (male, young, black), compounded with racism, contribute to the fact that society doesn't mobilize to address this problem and to demand an end to these deaths.

The campaign includes publicizing a number of statistics. Which fact surprised you the most?

The fact that surprised me the most was that Brazil more homicides than any country in the world. There were 56,000 murders in 2012. Of those, 30,000 victims were youth, and 77 percent of youth victims were black. Never has there been so much murder in Brazil, and it's shocking to see the selectivity of victims' profiles.

In the United States, there are protests going on about black youth killed by police. Do you see similarities between the #BlackLivesMatter movement in the United States and Amnesty's campaign?

Michael Brown's murder in August took place in a poor, black suburb. The same thing happens every day in Brazil. Black youth are the most affected by violence and we know that a part of these murders are the result of police action. Both in the United States and Brazil, there's a legacy of social exclusion and discrimination associated with black youth, which should be widely discussed and repudiated. The difference is that in the United States, the death of this young man by police stirred people and caused outrage, while in Brazil these stories rarely reach the back pages of newspapers and society deals with this as if violent death was the inevitable fate of these young people.

In Brazil, there have been local protests against people killed by police (like Amarildo, for example). In Brazil, could national protests take place as a result of a case like this?

That's our hope, but before that we need to break this pact of silence that exists in relation to these deaths, with rare exceptions. Society's indifference toward so many lives lost is one of our greatest disgraces. All of these deaths represent a tragedy and an irreversible loss. Society has a strategic role to ensure that this reality changes.

December 11, 2014

Over 550,000 Brazilians are incarcerated, making Brazil home to the fourth-largest prison population in the world. The number of prisoners grew 30 percent over the last two decades, meaning that over half a million prisoners are occupying space meant for less than 300,000. So it's no wonder that there are legal mechanisms in place to alleviate overcrowded jails. Some of these rules happen to be implemented around Christmas.

First, there's the annual pardon. Each year, the president issues a decree ending the sentences of eligible prisoners. These are typically non-violent offenders; last year, it affected those with a sentence of 8-12 years. In 2011, around 4,500 prisoners received the Christmas pardon. In recent years, the pardon has affected around 2 percent of the country's prison population annually.

There's also what's called the saidão, or the "big leave." This can happen up to five times a year for eligible prisoners: at Christmas/New Year's, Mother's Day, Easter, and other holidays. In order to receive this right to leave for a maximum of 7 days, a judge must approve. And it's not just any prisoner who can benefit: prisoners must be in semi-open prisons, have good behavior, and have served a sixth of their sentence if they're first-time offenders or a quarter if they're repeat offenders. Last year, over 34,000 prisoners were eligible for Christmas leave.

During their week away, prisoners are expected to be on their best behavior, and are not supposed to go out partying, for example. Plus, prison agents are supposed to conduct random home visits to make sure prisoners are playing by the rules. Sometimes, electronic ankle bracelets are used; in 2010, around 18 percent of those on temporary Christmas leave had to use them.

Despite the threat of increased sentences and further punishments for disobeying the conditions of temporary leave, in recent years around 5 to 7 percent of prisoners failed to return to jail. In 2012, more than 2,400 prisoners nationwide didn't come back from Christmas leave, around 5.1 percent of those who earned the saidão. That year, Sergipe had the largest desertion rate of any other state: around 21 percent. São Paulo--which has the country's biggest prison population--saw over 1,300 prisoners avoid returning to prison last Christmas.

Over time, the numbers add up. From 2003 to 2012, over 50,000 Brazilian prisoners on temporary leave failed to return to jail, according to a Folha de São Paulo report. Among those who went on the lam include several suspected murderers and a major drug trafficker.

August 24, 2014

Though Brazilians don't always take their grievances to the streets, making last year's demonstrations a surprise, they are known to be vocal about identifying the country's problems. Health is a case in point, whether it's complaining about the difficulty of getting a doctor's appointment or sharing videos on health care horror stories. (See: woman giving birth right outside a hospital due to lack of doctors or a doctor lamenting the state of health care.) During this election year, when you'll likely see a lot of analysis on how the economy will impact the vote, other top voter issues to pay attention to are the same ones brought up during the 2013 protests, particularly health care, corruption, and education.

Health care is something of a low-hanging fruit as far as voter issues go. With the growth of the new middle class and rising standards of living, more people are turning to private health care and many are demanding higher quality care. To put this issue in perspective, I've broken down some of the numbers involved in Brazilian health.

Surveys show that health care is increasingly identified as a problem in the country and an issue that should be prioritized. Released this month, a Datafolha poll contracted by the National Council of Medicine found that:

93 percent of Brazilians say that both public and private health care are okay, bad, or terrible. Of those who use the public health care system, 87 percent expressed dissatisfaction.

In the last two years, 92 percent of Brazilians used the public health care system, and 89 percent received assistance through this system. Most of those who had to wait to receive care (ranging from weeks to months) were women between 25 and 55 years old and of low income.

Around 57 percent said that health should be the federal government's priority, compared to 18 percent for education and 8 percent for fighting corruption.

Of those surveyed, 62 percent said health care overall was bad or terrible. Those who identified health care as such tended to live in larger cities, have more education, and higher salaries.

But it's not just the public system. Around 70 percent of those with private health care plans said their care was bad or terrible.

Around 47 percent said they would rather pay less taxes and buy private health care, and 43 percent said they'd rather pay high taxes and keep public care.

Access to Doctors

Though the Brazilian government has increased its health budget, the country still has an insufficient number of doctors. Brazil has 1.8 doctors per 1,000 people, above WHO's 1.4 minimum but below its neighbors (Argentina has 3.2, Uruguay has 3.7). This, despite the fact that the Ministry of Health tripled its public health system budget over the past 11 years, rising from $27.2 billion in 2003 to $91.6 billion this year.

For example, the state of Rio de Janeiro has around 16.2 million people, but only 58,000 doctors. At 3.6 doctors per 1,000, that's more than São Paulo, with only 2.6 doctors per 1,000. Amazonas, the country's largest state by geographic size, has only 4,000 doctors for 3.5 million people, or 1.1 per 1,000.

To tackle this problem, last year President Dilma Rousseff launched the "More Doctors" program, which imports medical professionals from abroad, with a large contigent from Cuba. There are now over 13,000 foreign doctors working throughout Brazil. While the program faced controversy, around three-quarters of Brazilians approve of More Doctors, according to an April poll.

In 2013, when the More Doctors program began, the country had about 374,000 practicising doctors, around 53,000 short. The program aims to have 2.7 doctors per 1,000 by 2017, and 600,000 total physicians by 2026.

Private Health Care on the Rise

Recent estimates show that around a quarter of Brazilians have private health care plans. (Datafolha put this number at 27 percent earlier this year.) At the end of 2012, there were around 48 million beneficiaries of private health care plans, a 17 percent increase from 2011, says a PricewaterhouseCoopers report. Plus, an estimated 8 out of 10 new private health care users come from the C class, or new middle class.

Edson de Godoy, CEO of AMILpar, one of Brazil's largest private health care providers, told Fortune: "Our competitive advantage is the deep knowledge of the three pillars that compose our market: hospital, laboratory, and the health-care plans. Brazil has been changing a lot in the last 10 to 15 years, and we have been open to these changes, especially to the market ones. If the society develops, we develop with it." Specifically, he explained, private health-care has become more available to lower income families, and as the government seeks to focus on health, the private sector can provide solutions.

The PwC report adds that the health insurance market is very fragmented, and that no hospital group has national coverage; all private hospitals operate only regionally. The greatest proof of the fragmentation of this market is that no Brazilian private hospital owns 1 percent of market share based on beds.

And though more people are turning to private care, it doesn't mean they're satisfied. Health insurance companies are the most complained about businesses, according to the Brazilian Consumer Defense Institute. Last year, health insurance companies made up nearly 27 percent of consumer complaints.

With plenty of new plans popping up, the government's regulator, the National Supplementary Health Agency, has penalized companies that don't provide care within a timely manner. For example, this month it temporarily suspended sales of 123 plans from 28 companies for failing to adhere to these time limits.

Health Care Expenses

Families spend around 7.2 percent of overall expenses on health, as of 2009, according to the Brazilian Institute of Geography and Statistics (IBGE). Around half of those expenses go to medications, and nearly a third to health insurance.

And while Brazil has a large public health care system, IBGE found that over 56 percent of health expenses come from consumers, with another 44 percent from public sector spending.

Though medical debt doesn't compare to the United States, some of the country's private hospitals, particularly in São Paulo, can charge astronomical prices for patients with serious and long-term illnesses. "Medicine must be treated as a social model. This current mercantilist model has a perverse logic and only ends in cruel results," Brazilian neurologist Rogério Adas told the BBC.in April.

Time is another issue. Along with shortages of doctors in ERs, patients sometimes end up waiting for physician care. As of February, there were over 300,000 pending cases demanding health services from the public system, Fernando Aith, a preventive medicine scholar at USP, told GlobalPost.